gms | German Medical Science

Objective: To establish a standardized surgical strategy and diagnostic workup of this special type of head-injury.

Methods: 167 patients with frontobasal injuries were operated with a minimum follow-up of 6 months. Data collection was performed prospectively.

Results: 138 patients presented with acute injuries, 24 patients were operated for recurrent CSF rhinorrhea, 5 had late infectious complications of former injuries. Surgery was delayed up to 4 weeks post-injury in most (n=106) of the acute patients whereas 32 had to be operated early for (space-occupying haematomas, large perforating injuries). 78 patients required additional surgery (e.g.for maxillofacial fractures). These were usually performed as one-stage procedures together with the neurosurgical operation. A standard bifrontal craniotomy with an intradural or combined intra-/extradural approach was used in all cases. 4 patients developed ascending meningitis in the preoperative period. As a result of surgical treatment 3 patients died, another 3 patients suffered from permanent, 4 from transitory neurological worsening. 4 patients had a recurrence of the CSF fistula within a three-month period but were successfully re-operated.

Conclusions: Our results show that the intradural approach is comparable in terms of morbidity, mortality, and success rate when compared to extracranial approaches with the additional "plus" of full visualization of the intracanial pathology. If possible surgery of more complex lesions should be delayed until the 2^nd or 3^rd week following trauma. With antibiotic prophylaxis, the risk of ascending meningitis until surgery is negligible. If the patient is stable and brain swelling has receded even extensive one-stage neurosurgical/maxillofacial procedures are well tolerated.